Optional_2023 Board Resources

Drug price reporting violations; 58 and

(j) (k)

Notifying a skilled nursing facility, home health agency, or community care setting of a survey. 59

4.2 Penalties . CMPs greatly range per violation; the following are common CMPs, which were recently increased by the OIG as part of a final rule made effective in February of 2017: 60 (a) $15,270 per false claim; (b) $104,826 per violation of EMTALA for hospitals with more than 100 beds. 4.3 Self-Disclosure Protocol . The OIG’s Self-Disclosure Protocol (SDP) 61 allows providers to voluntarily identify, disclose, and settle instances of potential CMPL liability. 62 The SDP guides providers on how to investigate the potential fraud internally, quantify damages, and ultimately report the matter conduct to OIG in order to resolve liability under the CMPL. 63 (a) Benefits . Significant benefits arise for providers who participate in the SDP: 64 (i) Good Faith Presumption . The OIG believes “that good faith disclosure of potential fraud and cooperation with OIG’s review and resolution process are typically indications of a robust and effective compliance program.” As a result of this indication of good faith compliance, OIG presumptively releases its exclusion authorities without requiring a corporate integrity agreement (CIA). (ii) Lessened Damages . OIG believes that a provider who participates in the SDP and cooperates with OIG during the SDP process “deserve[s] to pay a lower multiplier on single damages.” Further, the OIG’s routine practice is to require a minimum multiplier of 1.5 times the single damages, although the agency reserves the right to determine whether a higher multiplier is appropriate on a case-by-case basis. (iii) Overpayment Liability Protection . As discussed in Article 8 below, providers must report overpayments to the Centers for Medicare and Medicaid Services (CMS) within 60 days of identification. As part of its final rule published in 2016, CMS states that if a provider reports a self-identified

58 42 C.F.R. § 1003.1200. 59 42 C.F.R. § 1003.1300. 60 45 C.F.R. § 102.3.

61 “Provider Self-Disclosure Protocol,” Office of Inspector General: U.S. Department of Health and Human Services , available at https://oig.hhs.gov/compliance/self-disclosure-info/files/Provider-Self-Disclosure-Protocol.pdf (last accessed August 29, 2017). 62 Id at *1. 63 Id . 64 Id . at *2.